PEDIATRICS Section 2: Brain

Question 1

Extra-axial fluid spaces are considered enlarged if they are greater than ?

Answer 1

> 5 mm

Question 2

Etiology of BESSI “benign enlargement of the subarachnoid space in infancy.”

Answer 2

The etiology is supposed to be immature villa (that’s why you grow out of it).

Question 3

What is the most common cause of macrocephaly?

Answer 3

benign enlargement of the subarachnoid space in infancy (BESSI)

Question 4

Positive Cortical VEin sign

Answer 4

BESSI

Question 5

Diagnosis?

Answer 5

BESSI

Question 6

This is a collection of CSF in the subdural space sec to trauma (or idiopathic)

Answer 6

Subdural Hygroma (elderly)

Question 7

he cortical veins are displaced awav from the inner table - they are often not seen secondary to compression

Answer 7

Negative Cortial Vein sign in Subdural Hygroma

Question 8

When is BESSI present? and when does it resolve?

Answer 8

Present at 2-3 mos
common in males
Resolves after 2 years with no treatment

Question 9

BESSI has increased risk of what condition?

Answer 9

Subdural Bleed (spontaneous or minor trauma)

Question 10

This is the result of an ischemic / hemorrhagic injury, typically from a hypoxic insult during birthing.

Answer 10

Periventricular Leukomalacia ( Hypoxic-lsGhemic Encephalopathy of the Newborn)

Question 11

Who are at greatest risk of having Periventricular Leukomalacia ( Hypoxic-lsGhemic Encephalopathy of the Newborn)?

Answer 11

Premature (<1500g).

Question 12

What develops in 50% of Periventricular Leukomalacia ( Hypoxic-lsGhemic Encephalopathy of the Newborn)

Answer 12

Cerebral Palsy

Question 13

Explain the pathology of Periventricular Leukomalacia ( Hypoxic-lsGhemic Encephalopathy of the Newborn)

Answer 13

the pathology favors the watershed areas (characteristically the white matter dorsal and lateral to the lateral ventricles).

Question 14

Classic Periventricular Leukomalacia scenario

Answer 14

Premature/LBW

Question 15

In Periventricular Leukomalacia, the normal white matter should be less bright than what structure?

Answer 15

Choroid plexus

Question 16

In Periventricular Leukomalacia, this describes as the physiologic brightness of the posterosuperior periventricular white matter, this should be less bright than the choroid

Answer 16

“Blush”

Question 17

The difference between Flaring and PVL

Answer 17

Grade 1 PVL persists > 7 days.

Question 18

What are the lateral findings of PVL?

Answer 18

Development of cavitary periventricular cysts.

Question 19

Difference between Early and Subacute PVL

Answer 19

Question 20

The most Severe PVL (Grade 4), is more common in?
A. Full term infants
B. Preterms

Answer 20

A. Full term infants

Question 21

Mechanism of Germinal Matrix Hemorrhage

Answer 21

Mechanism: Fragile vessels + too much pressure/flow = bleeds

Question 22

Germinal Matrix Hemorrhage only exists in what type of infants?

Answer 22

An important thing to understand is that the germinal matrix is an embryological entity.

So it only exists in premature infants.

As the fetus matures the thing regresses and disappears.

Question 23

By 32 weeks, germinal matrix is only present at the ___?
By 36 weeks, what happens?\

Gamesmanship: Similar-looking bleed in a full-term infant, say ___?

Answer 23

By 32 weeks, germinal matrix is only present at the caudothalamic groove.
By 36 weeks, you basically can’t have it (if no GM, then no GM hemorrhage).

Take homepoint - No GM Hemorrhage in a full term infant.

Gamesmanship: Similar looking bleed in a fiill term infant say “choroid plexus hemorrhage” (not GMH).

Question 24

Who should be screened for Germinal Matrix Hemorrhage?

Answer 24

Premature Infants (<32 weeks, < 1500 grams).
Premature Infants with:
Lethargy
Seizures
Decreased Hematocrit
or a history of “he don’t look so good.”

Question 25

When do you do the head US?

Answer 25

First week of life (remember this is when 90% of them occur).

Question 26

Diagnosis?

Describe each!

Answer 26

(A) Grade 1: hemorrhage confined to the left germinal matrix (arrows).
(B) Grade 2: right germinal matrix hemorrhage extending into the lateral ventricle (arrows).
(C) Grade 3: left germinal matrix hemorrhage extending into the lateral ventricle with ventriculomegaly (arrows).
(D) Large intraparenchymal hemorrhage (arrows).

Question 27

Where is the germinal matrix located?

Answer 27

You tell them apart based on their location. Choroid should not extend anterior to the junction of the caudate and the thalamus (the so called caudothalamic groove).
This is the location of the germinal matrix.

Question 28

Diagnosis?

Answer 28

Grade I GM hemorrhage (Blood in the caudothalamic groove)

Question 29

What are the Secondary Consequences of hte GMH?

Answer 29

Question 30

Diagnosis?

Answer 30

Subependymal Cysts

Question 31

Diagnosis?

Answer 31

Porencephalic cyst

Question 32

Diagnosis?

Answer 32

Choroid plexus cysts

Question 33

Diagnosis?

Answer 33

Coarctation of the Ventricles